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Transient congenital hypothyroidism due to maternal thyrotrophin binding inhibiting immunoglobulin
Author(s) -
SCHWINGSHANDL J.,
DONAGHUE K.,
LUTTRELL B.,
COWELL C.,
WARD P.,
SILINK M.
Publication year - 1993
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/j.1440-1754.1993.tb00521.x
Subject(s) - medicine , euthyroid , transplacental , endocrinology , discontinuation , sibling , blocking antibody , thyroid , thyroiditis , antibody , fetus , pregnancy , receptor , immunology , psychology , developmental psychology , biology , placenta , genetics
Abstract Transient congenital hypothyroidism due to maternal thyrotrophin binding inhibitor immunoglobulin (TBII), a thyroid‐stimulating hormone (TSH)‐receptor blocking antibody, is described in three male siblings born to a mother with autoimmune thyroiditis. These cases are believed to be the first described in Australia. The first child was found to have a serum TSH of 565 mU/L and had a negative thyroid scan when presented for neonatal screening. He was treated with thyroxine but became thyrotoxic at 3 months of age when he was on a dosage of 85 μg/m 2 of body surface area. He was euthyroid 6 months after discontinuation of therapy. Nine years later a second hypothyroid sibling was born, with a serum TSH of 709 mU/L on day 4. Both mother and child were demonstrated to be strongly positive for TBIl. Again this child was able to cease therapy by the age of 9 months. A third sibling, also TBIl positive, was born 12 months after the second. His TSH was 90 mU/L and his serum thyroxine (T 4 ) was 169 nmol/L. On this occasion, thyroid stimulation‐blocking antibody was found to be present in the serum of both mother and child. Thyroxine therapy was ceased at 1 month. The family present a picture of varying degrees of transient neonatal hypothyroidism due to the transplacental passage of a maternal receptor blocking antibody. The condition is self‐limiting, resolving when the immunoglobuiin is cleared from the infant's circulation.